Please fill out the Stop Smoking Questionnaire below.
Your answers will provide me with valuable information about your smoking habits, thought processes and beliefs that have tended to keep you smoking until now. I will use this information to have a great understanding of what needs to change to free you from smoking most easily. Please add to your smoking questionnaire any information that you think might be relevant and useful. Once you've finished, click SUBMIT and your form will come straight through to me. Many thanks!